OBSERVATIONS ON PULMONARY EMBOLISM AND THE PULMONARY ANGIOGRAM

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Abstract
1. Pulmonary angiograms and data obtained from right heart catheterization, especially when combined with unilateral pulmonary artery balloon occlusion, were complementary and important diagnostic methods in the detection and definition of emboli in 38 out of 58 patients referred with a diagnosis of "possible pulmonary embolism." 2. The angiogram often demonstrates more extensive thrombus collection within either or both lung fields than would be suspected from conventional studies. 3. Large thrombi may be present without recognizable clinical or chest roentgenographic alteration. The embolic event may be followed by a silent period with clinical symptoms produced by later obstruction of more peripheral vessels. Similarly, there may be a lag in the embolic event and the production of a roentgen density. Serial roentgenograms are necessary to demonstrate transient parenchymal changes. 4. Emboli may be directly identified, either as arterial obstructions with abrupt cut-off of the affected vessel, a filling defect, or as localized arterial stasis. Additional diagnostic signs include segmental diminution in flow, poor capillary filling, avascularity, and diminished, or absent venous return from the affected area. 5. Multiple small emboli, which affect peripheral vessels, can be recognized by a segmental vascular change characterized by shortened, plump and wavy branch vessels, relatively sparse peripheral filling and tortuosity of the visualized distal branches. 6. Overpenetrated plain roentgenograms emphasizing the lower lobes in an attempt to recognize avascular areas or distorted vessels are suggested in order to extend conventional diagnostic efforts.

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